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endocrine > DKA > Flashcards

DKA Flashcards

1
Q

what are the diagnostic criteria for DKA?

A

glucose >11
pH <7.3 or bicarb <15
ketones >3 in blood or 2+ or more in urine

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2
Q

what is DKA a complication of?

A

T1DM or rarely T2DM

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3
Q

what are the different severities for DKA?

A

mild: pH <7.3, bicarb <15, 5% dehydrated
moderate: ph <7.2, bicarb <10, 5% dehydrated
severe: pH <7.1, bicarb <5, 10% dehydrated

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4
Q

why is it important to frequently check an insulin pump?

A

if an insulin pump stops working for 8-10 hours they can go into DKA

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5
Q

what are some potential causes/triggers of DKA?

A

infection
cessation of insulin/inadequate insulin
CVD eg stroke, MI
drugs eg steroids, thiazides, SGLT2s
recreational drugs eg cocaine, MDMA

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6
Q

what are the clinical features of DKA?

A

polyuria
polydipsia
vomiting
dehydration
altered mental state
coma
weakness
lethargy
kussmaul respiration
acetone breath smell

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7
Q

what is kussmaul breathing?

A

deep, rapid, and labored breathing at a consistent pace

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8
Q

what are the bedside investigations for DKA?

A

classic A-E-look for cause, infection, etc
cap BM-v high
urine dip -ketone ++, glucose +ve
12 lead ECG -?MI, monitor for arrhythmias

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9
Q

what are the blood tests for DKA?

A

plasma glucose -high
FBC -?infection
CRP -?infection
U+E
plasma osmolality
cardiac enzymes -?MI
ck -?rhabdo
amylase -?pancreatitis
blood cultures -?sepsis
VBG

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10
Q

what would you see in U+Es of DKA?

A

Na+ may ne high due to dehydration or low due to sugar pulling water +Na+ out of cells
K+ may be high due to acidosis, normal, or low
urea and creatinien may be raised due to dehydration and potentially AKI

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11
Q

what is the plasma osmolality in DKA?

A

> 290

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12
Q

what does the VBG for DKA show?

A

metabolic acidosis
low pH
low HC03-
anion gap usually >13
>16 shows v severe DKA

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13
Q

how do you work out anion gap?

A

positive ions -negative ions (Na+ +K+) -(Cl- -HC03-)

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14
Q

what blood ketone level would signify severe DKA?

A

> 6

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15
Q

what are the main treatment points of DKA?

A

IV fluids and electrolyte replacement if needed
insulin
regular monitoring
treat underlying cause

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16
Q

what is the IV fluid treatment in DKA?

A

follow trust guidelines but:
initial wide bore cannula and bolus resuscitation with 0/9% saline
then maintenance fluids:
0.9% saline 1L over 1 hour
then you can add potassium (KCl) if needed
if glucose falls to less than 14, give 10% glucose at 125ml/h alongside the other fluids

17
Q

what do the different potassium levels mean in DKA?

A

> 5.5: don’t give potassium
3.5-5.5: give 40mmol/L of KCl
<3.5: senior review

18
Q

how should you manage insulin in DKA?

A

fixed rate IV insulin infusion (FRIII) -50 units made up to 50ml with 0.9% NaCl, infuse at fixed rate of 0.1U/kg/h
need to wait an 1-2h before giving in kids!
continue the FRIII until ketones <0.6, pH >7.3, HC03- >18.
never stop their normal long acting insulin!

19
Q

how do you monitor a patient with DKA?

A

measure BMs and cap ketones hourly
VBG at 60min and 2h after and every 2h after that

20
Q

what is the difference in DKA management in paeds?

A

give 02
different fluids
need to wait to give insulin
check pee before giving K+
monitor closely for cerebral oedema

21
Q

what is the fluid treatment for DKA in paeds?

A

if not shocked: 10ml/kg NaCl over 60 min
if shocked: 10ml/kg NaCl over 5-10min, repeat to max of 4x before calling PICU if still shocked
after 1st hour can add potassium 40mmol/L KCl to fluid
only add KCl if K+ <5.5 and child can pee/wet nappy
add 5% dextrose if BM <14

22
Q

what is the insulin treatment for kids with DKA?

A

1-2 hours post fluids, start FRIII 0.05-0.1U/kg/h. absolute no to give before 1h post fluids-risk of cerebral oedema

23
Q

what are the targets for how fast ketones and bicarb should be changing in DKA management?

A

ketones -decreasing by 0.5mmol/h
bicarb -increasing by 3mmol/h

24
Q

what are the criteria for an episode of DKA to be resolved?

A

glucose >11.1
bicarb >18
pH >7.3
anion gap <10

25
Q

what are the symptoms of cerebral oedema?

A

fluctuating consciousness, altered MS
heart rate deceleration, esp >20bpm
rising BP
age-inappropriate incontinence
vomiting
headache
lethargy
irritability

26
Q

what is cushing’s reflex and cushing’s triad?

A

cushing’s reflex: relfex in response to raised ICP that leads to cushing’s triad: widened pulse pressure, bradycardia, irregular respirations

27
Q

when can cerebral oedema happen in DKA?

A

usually within 12h of DKA but can be up to 48 hours after it’s started

28
Q

what is the 1stline investigation for cerebral oedema?

A

full body CT -look for extent of oedema, rule out differentials, look for thromboses

29
Q

what should you do if a child being treated for DKA starts developing symptoms of cerebral oedema?

A

3% NaCl or IV mannitol
call PICU /anaesthetist
consider CT brain

endocrine (6 decks)

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